RAVECAB: Improving outcome in off-pump minimal access surgery with robotic assistance and video enhancement

Walter D Boyd, B. Kiaii, R. J. Novick, R. Rayman, S. Ganapathy, W. B. Dobkowski, G. Jablonsky, F. N. McKenzie, A. H. Menkis

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

Objective: To determine the efficacy of using the harmonic scalpel and robotic assistance to facilitate thoracoscopic harvest of the internal thoracic artery (ITA). Design: A case series. Setting: London Health Sciences Centre, University of Western Ontario, London, Ont. Patients and methods: Fifteen consecutive patients requiting harvest of the ITA for coronary artery bypass grafting. Intervention: Robot-assisted, video-enhanced coronary artery bypass (RAVECAB) through limited-access incisions, using the harmonic scalpel and a voice-activated robotic assistant. Main outcome measures: Ease and duration of the harvesting technique, complications of the procedure, graft flow and patency, and duration of postoperative hospitalization. Results: RAVECAB facilitated thoracoscopic dissection of the ITA with the harmonic scalpel in all cases. There were no conversions to a standard approach and no reoperations for bleeding. The mean (and standard deviation) ITA harvest time was 64.1 (22.9) minutes (range from 40 to 118 minutes). Robotic voice command capture rate was greater than 95%. Mean (and SD) intraoperative graft flows were 33.1 (26.8) mL/min (range from 14 to 126 mL/min). There was 100% graft patency on postoperative angiography. There were no deaths, perioperative myocardial infarction or arrhythmias. Mean (and SD) postoperative hospitalization was 3.3 (0.8) days. Conclusions: RAVECAB is a demanding procedure that addresses many of the disadvantages of the "conventional" minimally invasive coronary artery bypass. It allows complete pedicle dissection with minimal ITA manipulation and assures sufficient conduit length and a tension-free coronary artery anastomosis. All anastomoses were performed under direct vision through a 5- to 8-cm inferior mammary incision.

Original languageEnglish (US)
Pages (from-to)45-50
Number of pages6
JournalCanadian Journal of Surgery
Volume44
Issue number1
StatePublished - 2001
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Boyd, W. D., Kiaii, B., Novick, R. J., Rayman, R., Ganapathy, S., Dobkowski, W. B., Jablonsky, G., McKenzie, F. N., & Menkis, A. H. (2001). RAVECAB: Improving outcome in off-pump minimal access surgery with robotic assistance and video enhancement. Canadian Journal of Surgery, 44(1), 45-50.